Carly Fiorina, the former Hewlett-Packard CEO running against Barbara Boxer for the U.S. Senate, wants to repeal the health care bill enacted this year by Congress and President Obama. The new law, Fiorina predicts, will cost the taxpayers more than advertised, do nothing to rein in health care costs and make it more difficult for people to find a doctor.
In an interview, Fiorina said she wants Congress to replace the bill with a more modest set of individual initiatives designed to solve specific problems rather than a comprehensive bill to overhaul the entire health care industry.
“A funny thing happened on the path to health care reform,” Fiorina said. “It started out being a discussion about making quality, affordable health care accessible to everyone. And I agree with those goals. And along the way it became health insurance reform. … What we now have actually doesn’t solve any of the problems that true health care reform was intended to solve.”
Fiorina said the 2,600-page reform plan seeks to “boil the ocean” rather than target the most serious problems in the current system with narrowly crafted solutions.
Despite her differences with the Democrats’ plan, though, Fiorina’s positions on health reform are not all in line with Republican or conservative dogma. For example, she favors allowing the importation of drugs from Canada, a practice many conservatives say would amount to de facto price controls, since Canada’s government controls drug prices and those prices, being below market in the United States, would set the new standard here.
Fiorina also favors a government solution to the problem of people being denied coverage because of pre-existing conditions. Rather than requiring insurers to cover everyone regardless of their medical history, Fiorina says she likes the idea of a high-risk pool for those who are denied coverage. The health reform does that as a temporary measure until 2014, but then replaces the state-run pools being created this year with a requirement that insurers cover everyone.
“People with pre-existing conditions who should be able to get coverage can’t,” Fiorina said. “Let's tackle that specific problem. You could do it in a variety of ways. You could create a high-risk pool. You could subsidize the high-risk pool. You could force insurance companies to participate in the high-risk pool. And you could solve that problem. Would it cost some money? Of course. But it wouldn’t cost this much money.”
Expand community clinics
Fiorina’s position on expanding access to care for low-income Americans also relies less on the insurance industry and more on direct or indirect provision of health care by the government. She says she would like to see a major expansion of community clinics. The federal health care bill does that, but Fiorina says it does not go far enough. Most low-income people who can’t get care elsewhere should be able to go to a clinic, a solution Fiorina believes is far simpler, and probably less expensive, than having a private insurance policy subsidized for them by the government.
“If you have a population of whatever the number is who are not able to get care, then deal with that problem,” she said. “There’s a big difference between insurance and care. If we had more low-cost clinics available for routine care, somebody doesn’t need health insurance to go get them, they can go use services and those clinics can be subsidized. That’s a very different approach than what we did in this bill.”
She also said: “We know if people have access to low-cost clinics for routine care they will take advantage of them. Most people who go to an emergency room for a fever don’t go there because it’s what they choose, its because that’s all they have available to them.”
Medicare cost-savings won’t happen
Fiorina said she does not believe that the cost-savings the bill envisions for Medicare will ever materialize.
“While I think everyone would applaud the notion that we need to root out fraud, waste and abuse, I know you don’t do that unless someone is accountable for doing that. What are our goals, what are our metrics, who’s in charge? How will we know if we are getting it done? None of that is in place. Five-hundred billion dollars won’t just magically disappear from Medicare. In fact the president just recently said we need to put $500 billion into Medicare. Costs are going up, not down. We didn’t solve that problem.”
Fiorina, who was diagnosed with stage II breast cancer last year and treated with surgery, chemotherapy and radiation, said she believes one way to cut costs is to develop more “integrated care” and to give doctors incentives to follow practices proven through clinical studies to be the most effective.
Fiorina has insurance through United Health Care and was treated at the Stanford Medical Center, which is considered a top cancer-treatment facility.
“The people who cared for me were unbelievably wonderful,” she said. “The fact that I lived so close to one of the premier cancer centers in the world, how blessed am I? But in terms of, I’m not, I’m not picking on Stanford because they are a wonderful facility, but there are many, many opportunities for more efficient and therefore less costly processes, if there was a focus on patient-centered care and integrated care.”
When she went to the hospital for her chemotherapy infusions, she said, her blood pressure was taken numerous times on each visit.
“It made absolutely no difference in my care,” she said. “It deteriorated the quality of my experience and it cost a hell of a lot of money.”
To save money, Fiorina said, Congress should adopt caps on malpractice judgments the way California did in the 1970s. That would lower costs for the malpractice insurance doctors must buy while also reducing the practice of “defensive medicine” that prompts some physicians to order every possible test and procedure to make sure they are covered in case a patient later sues.
Beyond that, Fiorina is a fan of the kind of incentive-based health plan that the Safeway grocery chain has adopted in recent years for its non-union employees.
Tie health insurance premiums to behavior
“We know that when people's cost of health care is tied to the healthy choices they make, they make better choices,” she said. “At Safeway if you’re a smoker, the cost of your copay is increased. If an employee is told, 'The cost of your copay will go down if you quit smoking,' guess what? They’ve had pretty good success with people quitting smoking. They’ve had good success with people getting their weight under control. In other words, tie healthy choices and prevention to the cost of health care in a way that benefits the individual and benefits the system.”
Fiorina said she favors allowing consumers to import drugs from Canada that have been shipped there from the United States. She thinks the Democrats who negotiated the details of the reform plan gave up on that idea in order to gain drug industry support for the comprehensive measure.
“Why shouldn’t we have competition for pharmaceuticals?” she asked. “Why shouldn’t people be able to import drugs from Canada? I’m all for it. And yet that deal, that opportunity to lower costs was taken off the table because the pharmaceuticals came to the table early on and said, ‘We’ll support health care reform.’”
One popular aspect of the bill that Fiorina doesn’t like is its provision requiring insurance companies to cover children on their parents’ plan until the age of 26. She sees the mandate as unnecessary and probably something that undermines personal responsibility.
“When I was 26 years old, I recognize I’m not the same as everyone else, but I was worried about making my own living, not going on my parents' health insurance plan,” she said. “I’m not saying it’s not a good thing for some people. But I’m not sure that it’s an unalloyed good. If you dealt with the issue of making sure people with pre-existing conditions are able to get coverage and care, if you dealt with some of the central issues, I’m not sure you would even consider that a desirable thing.”